Map of life expectancy at birth from Global Education Project.

Thursday, January 07, 2010

Why Steven Hawking is . . .

. . . dead. Whoops! He isn't. But as you may recall, Investors Business Daily wrote this about him:

People such as scientist Stephen Hawking wouldn't have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless.

And that's essentially Sarah Palin's claim as well, that her(?) son Trig, who has Down Syndrome, would be left to die if we adopted "rationing" as those Godless Brits have done. Since Hawking is in fact a subject of HRH Elizabeth II, and he does in fact receive health care which has almost miraculously extended not only his life but also his productive career despite his suffering from ALS, Investors Business Daily obviously got this wrong somehow. But how exactly?

The UK does indeed have an agency, called the National Institute for Clinical and Health Excellence (abbreviated NICE for both historical reasons -- "Health" got added later -- and because it sounds nicer), which does indeed decide whether treatments are worth paying for, and it does indeed include cost as well as benefit in that analysis. What it does not do, however, is pay any attention to who the individual is who is receiving a treatment, or make any judgment whatsoever about the worth of any given person's life vs. that of any other person. There are no death panels. And yet, and yet, there is rationing.

Despite engaging in the Godless Communistic Fascistic practice of rationing, the Brits manage to live longer than we do and be happier with their medical care than we are, as I have recently shown y'all. We just can't have this conversation in the U.S. without screaming mobs descending on the interlocutors with guns on their hips and Auschwitz on their placards, but we're going to have it here anyway, and we're going to get it straight. I'm not saying it's simple, or that there are no ethical difficulties or hard choices to be made. There are, but other societies have managed to make them without collapsing into nihilism. So let's give it a try, okay?

As I pointed out a few days ago, once we get past our initial intuitions about the imperative to rescue people in desperate straits, we do have conclude that there is some limit beyond which it is just not worth spending immense amounts of money for a very small marginal extension of life, even meaningful life. There are other compelling uses for resources and in fact, there are absolute limits. If we spend ten million dollars on one person, that means, a fortiori, that there are other people on whom we can spend nothing, because our resources after all are not infinite. Drawing the line, and rationing resources, do not mean somehow increasing the sum of human deprivation. They mean trying to assure some modicum of justice and making the best use of the resources we do have.

So the question is, how can we go about that in a way that most people will accept as fair? If anyone has thoughts about this, I'd love to hear them. I'll discuss the current state of the art, and my own opinions about it, starting next time.

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